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ACANTHAMOEBA ENDOPHTHALMITIS AFTER RECURRENT KERATITIS AND NODULAR SCLERITIS

Mammo, Zaid MD; Almeida, David R. P. MD, MBA, PhD; Cunningham, Matthew A. MD; Chin, Eric K. MD; Mahajan, Vinit B. MD, PhD

doi: 10.1097/ICB.0000000000000323
Case Report

Purpose: To describe the clinical course of a patient with Acanthamoeba keratitis, who despite prompt treatment progressed to histopathology-confirmed Acanthamoeba retinitis and endophthalmitis.

Methods: Case report.

Results: A healthy 30-year-old male wearing soft contact lens was diagnosed with Acanthamoeba keratitis and treated medically and surgically over the course of 1 year with presumed resolution of the infection. Yet, his infection recurred with documented spread to sclerokeratitis, and overwhelming endophthalmitis. Concerns about extra-ocular spread prompted a therapeutic enucleation with histopathologic evidence of Acanthamoeba organisms throughout the globe.

Conclusion: This is a case of a severe recurrent Acanthamoeba infection presenting initially as keratitis, followed by sclerokeratitis and histolopathology-confirmed endophthalmitis. This case demonstrates that despite persistent medical and surgical intervention, eradication of organisms may not be possible.

Extra-corneal manifestations of Acanthamoeba keratitis are uncommon but may be sight-threatening. These manifestations include sclerokeratitis and rarely posterior segment involvement. We describe the clinical and histopathologic findings of a rare case of Acanthamoeba keratitis which progressed to infectious sclerokeratitis and endophthalmitis.

*Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada;

VitreoRetinal Surgery, PA, Minneapolis, Minnesota;

Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa city, Iowa; and

§Department of Ophthalmology, Omics Laboratory, Iowa City, Iowa.

Reprint requests: Vinit B. Mahajan, MD, PhD, Department of Ophthalmology, Omics Laboratory, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: vinit-mahajan@uiowa.edu

Supported by Research to Prevent Blindness.

None of the authors have any conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.